Body Function Level Research Articles

Between-Day Reliability of the Gait Characteristics and Their Changes During the 6-Minute Walking Test in People With Multiple Sclerosis

Background Gait characteristics and their changes during the 6-minute walking test (6MWT) in people with multiple sclerosis (pwMS) have been described in the literature, which one may refer to as walking fatigability in the body function level of the International Classification of Functioning, Disability, and Health. However, whether these metrics are reliable is unknown. Objective To investigate the between-day reliability of the gait characteristics and their changes in pwMS and healthy controls (HCs). Methods Forty-nine pwMS (EDSS 4.82 ± 1.22 and 54.7 ± 9.36 years) and 23 HCs (50.6 ± 6.1 years) performed the 6MWT, as fast as possible but safely while wearing Inertial Measurement Units. Gait characteristics were measured in the pace, rhythm, variability, asymmetry, kinematics, coordination, and postural control domains and were obtained in intervals of 1 minute during the 6MWT. In addition, gait characteristics change in the last minute compared with the first minute were calculated for all gait variables using a fatigability index (ie, distance walking index). The intraclass correlation coefficient (ICC), Bland–Altman Plots, and Standard error of measurement were applied to investigate reliability. Results Reliability of gait characteristics, minute-by-minute, and for their changes (ie, using the fatigability index) ranged from poor to excellent (pwMS: ICC 0.46-0.96; HC: ICC 0.09-0.97 and pwMS: ICC 0-0.72; HC: ICC 0-0.77, respectively). Conclusion Besides coordination, at least 1 variable of each gait domain showed an ICC of moderate or good reliability for gait characteristics changes in both pwMS and HC. These metrics can be incorporated into future clinical trials and research on walking fatigability. Clinical Trial Registration: NCT05412043.

Environment-based approaches to improve participation of young people with physical disabilities during COVID-19.

To examine the effects of the Pathways and Resources for Engagement and Participation (PREP) intervention during the COVID-19 pandemic on (1) activity performance and satisfaction, and (2) motor, cognitive, and affective body functions. An interrupted time-series design with multiple baselines across 21 young people (13 females, eight males) aged 16 to 25 years (median = 21 years 5 months) with physical disabilities was employed. The young people engaged in an 8-week self-chosen leisure activity (e.g. football, piano, photography) at their home or community. The Canadian Occupational Performance Measure (COPM) assessed activity performance and satisfaction weekly. Mental health problems, including affective and cognitive outcomes, were assessed weekly using the Behavior Assessment System for Children, Third Edition. Motor functions (e.g. trunk control, reaching, strength) were assessed biweekly. Linear mixed-effects models were used. The intervention had large effects on activity performance (0.78) and satisfaction (0.88) with clinically significant change in COPM scores (2.6 [95% confidence interval {CI}: 2.0-3.2] and 3.2 points [95% CI: 2.4-3.9] respectively). Young people without mental health problems at baseline benefited more from the intervention (p = 0.028). Improvements in at least one domain of body function occurred in 10 young people especially for motor outcomes. Results demonstrate the effectiveness of PREP during adverse times and suggest benefits going beyond participation, involving outcomes at the body-function level. Environmental-based interventions can improve participation even during adverse times such as the COVID-19 pandemic. Significant improvement with large effect sizes occurred in both activity performance and satisfaction. Intervention was effective for all; those without mental health problems benefited more. Improvements in body-function outcomes were partially observed, especially in motor-related outcomes. Body functions may improve through participation even if not targeted by the intervention.

Exercise Prescription in Patient with Different Complications of Leukemia

Common treatment of leukemia will have side effects on nerve function, affecting the patient's physical function, which makes patients often accompanied by infection, bone and joint pain, fatigue and other symptoms. Exercise can improve the level of body function, enable patients to tolerate stronger chemotherapy during treatment, help improve the survival rate and recovery chances of patients, and has been used as an effective means to promote recovery. Recommendations for leukemia and exercise have been primarily based on the results of existing relevant studies. To provide more targeted recommendations for the leukemia, we gathered evidence for the efficacy of exercise for leukemia, and concluded with recommendations for exercise prescription for the rehabilitation of patients with leukemia during and after chemotherapy. We used "leukemia", "exercise" as keywords, retrieving related literatures in CNKI, VIP, Wanfang, PubMed and Web of Science databases by December 20, 2021. Based on the analysis of research methods and outcome indicators, we extracted the exercise prescription for leukemia patients. Relative safe and effective exercise prescriptions were obtained for leukemia patients. For example, for patients with cardiopulmonary injury, a 6-minute walk can be more safely used for testing, aerobic exercise can be performed for 3-5 days/week, and each exercise time can be gradually increased from 10min to more than 30min. Also, it may be more effective to replace HHR (40%~59%) with RPE (12~13) for their intensity monitoring. Therapeutic exercise, especially with an element of strengthening combined with aerobic training, is an efficacious treatment for leukemia. Notably, with the development of technology, the ways of exercise available are diversifying, many complementary training methods such as Spotlight program, Team works, are also effective. At the same time, multi-mode, remote and home interventions are becoming more and more popular, providing a new direction for patient prognosis. However, the prescription recommendations are only for practical reference. There are insufficient high quality studies on exercise rehabilitation and prescription for patients with leukemia and various complications, and more research support is needed to develop more accurate exercise prescription.

Systematic evaluation of the guidelines for rehabilitation in multiple sclerosis patients: an overview according to ICF functioning domains.

High-quality clinical practice guidelines (CPGs) can provide evidence-based recommendations for optimizing care on managing multiple sclerosis (MS). There is currently no review that compiles recommendations of high-quality CPGs to guide decision-making for MS rehabilitation. The aim was to identify evidence-based recommendations in high-quality multidisciplinary English CPGs for rehabilitation in MS. CPGs published in the last 10 years (2009-2019) that described recommendations on rehabilitation were searched in PubMed, Turning Research into Practice database, International Guideline databases, National Guideline databases and websites of MS organizations. Quality assessment of CPGs was conducted by two evaluators using the Appraisal of Guidelines for Research and Evaluation II instrument. Recommendations were classified according to the International Classification of Functioning, Disability and Health (ICF) and the International Classification of Health Intervention (ICHI) and documented in terms of strength of recommendation and level of evidence. Five CPGs satisfied the inclusion criteria. Of 120 recommendations, 38 had a strong level with moderate to low level of evidence, 61 were of weak strength and 18 were formulated by the consensus of experts. Recommendations were categorized into 12 domains and 1 chapter on the body function level, 1 chapter on activity level and 2 domains on external factors. The existing CPGs demonstrated more than 100 evidence level recommendations to be followed at the clinical practice, most in body functions of the ICF. Developing up-to-date CPGs with more focus on activity and participation domains for countries with various healthcare backgrounds may be useful for a best clinical practice.

Research Progress on the Effect of Exercise Rehabilitation on Functional Level and Physical Fitness

The essence of rehabilitation is the recovery and reconstruction of body function,and cardiopulmonary function is not only the core of body function, but also the core element of physical fitness. As one of the important interventions of modern rehabilitation treatment, exercise rehabilitation is the fundamental way to improve the level of body function, and plays a key role in the process of disease rehabilitation. The forms of exercise rehabilitation are widely used in clinic including aerobic exercise, high intensity interval training,muscle strength training, and traditional exercise and so on. Different forms of exercise rehabilitation can improve the level of body function and promote physical fitness in varying degrees. The main functions include regulating blood pressure, blood lipids and blood glucose, improving balance and muscle strength,increasing bone mineral density, enhancing cardiorespiratory fitness and walking ability, improving cognitive and memory functions,regulating emotions, promoting mental health, and improving the quality of life, etc., so as to achieve the goal of shortening the process of disease rehabilitation and improving its curative effect. However, there are differences in the dimensions and degrees of the influence of different forms of exercise rehabilitation on functional level and physical fitness. Among them, aerobic exercise mainly has a positive impact on cardiorespiratory fitness, glucose and lipid metabolism,emotional regulation, cognition and memory and other dimensions, and its mechanism involves the increase of endogenous cannabinoid in circulation and the integrity of white matter fibers and so on. Compared with moderate intensity aerobic exercise, high intensity interval training can improve cardiorespiratory fitness and cardiac metabolic health more timely and its mechanism involves the increase of muscle mitochondrial production capacity and the regulation of partial gene expression in skeletal muscle. Muscle strength training can improve blood glucose control and reduce the risk of chronic diseases and death by increasing muscle strength and endurance, especially for postmenopausal women and overweight/obese elderly. Traditional exercises, such as Taijiquan and Baduanjin, are important interventions of rehabilitation in traditional Chinese medicine, which have definite effect in improving balance, cognition and memory, and are worthy of clinical promotion and application. At present, how to choose the best form of exercise rehabilitation and the best course of treatment for people with different functional disorders and different disease status remains to be further clarified by follow-up clinical and basic research.

Do immediate intramuscular co-administration of diclofenac and dexamethasone or extraoral ice pack application have any influence on pain perception and oral health related quality of life (OHRQoL) following trans-alveolar extraction of impacted mandibular third molars? A comparative study in a Saudi Arabian sub-population

Pain perception and QoL are fundamental enquiries patients wants to know regarding trans-alveolar extraction of lower third molar. The current study hopes to compare the influence of co-administration of diclofenac+dexamethasone and icepack on pain and QoL after trans-alveolar surgery of lower third molar. This was a prospective study of patients referred for trans-alveolar extraction of mandibular third molar teeth under local anesthesia. Patients were randomly assigned into Group A (co-administered IM Dexamethasone 8 mg and IM Diclofenac 75 mg in office) and Group B (ice packs extra-orally). Assessment of pain was carried out using the numerical pain rating scale. Validated Arabic version of the 16 item United Kingdom Oral Health Related Quality of Life measure (UK-OHRQoL) was used to evaluate the QoL pre and on the POD's. A total of 78 patients equally distributed into Groups A and B were the study participants. The mean age was 31.6 ± 6.4 years (Group A: 32.5 ± 5.5 and Group B: 30.8 ± 7.2, range 20–48years). The M:F ratio was 1:1.1. Better pain reduction was observed in Group A which became significant (p = 0.019) on POD 3. Domain scores was better in the Group A patients at the body function level (p = 0.016) and personal level (p = 0.013) at POD 1 and body function level (p = 0.044) at POD 3. Overall QoL scores was also better in the Group A with significant difference (p = 0.025) on POD 1. Pain perception, domain and overall QoL scores continues to improves throughout the review period with better improvement in the Group A.

Psychometric Evaluation of the ACHIEVE Assessment.

Objective: There has been a significant change within clinical practice in childhood disability from “treating” at the level of body function to ecological approaches that address the child's involvement in everyday life. Clinical assessment, and robust tools to support this, are of key importance. The aim of this study was to assess the psychometric properties of the ACHIEVE Assessment in a clinical dataset. The ACHIEVE assessment is a parent and teacher report of participation in home, school and community settings, important contributory factors for participation, and environmental factors.Design: ACHIEVE scores of children were collected from parents and teachers. The Rasch Rating Scale Model produced model estimates with WINSTEPS software.Setting: Clinical rehabilitation settings in Scotland (United Kingdom).Subjects: 401 parents and 335 teachers of 402 children participated resulting in a final sample of 736 responses. Children (78% male) were 4–17 years old (mean 7.91 years SD 2.61). Children had a range of disabilities including Developmental Coordination Disorder, Autism Spectrum Disorder, and Attention Deficit Hyperactivity Disorder.Results: The study includes a large clinical sample of children with disabilities. The results demonstrate that the ACHIEVE Assessment can provide unidimensional measurements of children's participation and important contributory factors for participation. Differential item functioning analysis indicated majority of items were comparable between parent and teacher report.Conclusions: The results confirm evidence of appropriate psychometric properties of the ACHIEVE Assessment. ACHIEVE is a comprehensive tool that enables identification of patterns and issues around participation for clinical and research purposes.

Standardized Measurement of Quality of Upper Limb Movement After Stroke: Consensus-Based Core Recommendations From the Second Stroke Recovery and Rehabilitation Roundtable

The second Stroke Recovery and Rehabilitation Roundtable “metrics” task force developed consensus around the recognized need to add kinematic and kinetic movement quantification to its core recommendations for standardized measurements of sensorimotor recovery in stroke trials. Specifically, we focused on measurement of the quality of upper limb movement. We agreed that the recommended protocols for measurement should be conceptually rigorous, reliable, valid and responsive to change. The recommended measurement protocols include four performance assays (i.e. 2D planar reaching, finger individuation, grip strength, and precision grip at body function level) and one functional task (3D drinking task at activity level) that address body function and activity respectively. This document describes the criteria for assessment and makes recommendations about the type of technology that should be used for reliable and valid movement capture. Standardization of kinematic measurement protocols will allow pooling of participant data across sites, thereby increasing sample size aiding meta-analyses of published trials, more detailed exploration of recovery profiles, the generation of new research questions with testable hypotheses, and development of new treatment approaches focused on impairment. We urge the clinical and research community to consider adopting these recommendations.

Standardized measurement of quality of upper limb movement after stroke: Consensus-based core recommendations from the Second Stroke Recovery and Rehabilitation Roundtable.

The second Stroke Recovery and Rehabilitation Roundtable "metrics" task force developed consensus around the recognized need to add kinematic and kinetic movement quantification to its core recommendations for standardized measurements of sensorimotor recovery in stroke trials. Specifically, we focused on measurement of the quality of upper limb movement. We agreed that the recommended protocols for measurement should be conceptually rigorous, reliable, valid and responsive to change. The recommended measurement protocols include four performance assays (i.e. 2D planar reaching, finger individuation, grip strength, and precision grip at body function level) and one functional task (3D drinking task at activity level) that address body function and activity respectively. This document describes the criteria for assessment and makes recommendations about the type of technology that should be used for reliable and valid movement capture. Standardization of kinematic measurement protocols will allow pooling of participant data across sites, thereby increasing sample size aiding meta-analyses of published trials, more detailed exploration of recovery profiles, the generation of new research questions with testable hypotheses, and development of new treatment approaches focused on impairment. We urge the clinical and research community to consider adopting these recommendations.

Effect of continuous intrathecal baclofen therapy in children: a systematic review

AimTo investigate the effects of continuous intrathecal baclofen (ITB) therapy in children with cerebral palsy (CP) and other neurological conditions.MethodThis systematic review was conducted using standardized methodology, searching four electronic databases (PubMed, Embase, CINAHL, Cochrane Library) for relevant literature published between inception and September 2017. Included studies involved continuous ITB as an intervention and outcome measures relating to all International Classification of Functioning, Disability and Health: Children and Youth (ICF‐CY) components.ResultsThirty‐three studies were identified, of which one, including 17 children with spastic CP, produced level II evidence, and the others, mainly non‐controlled cohort studies, level IV and V. Outcomes at body function level were most frequently reported. Results suggest continuous ITB may be effective in reducing spasticity and dystonia in CP, as well as other neurological conditions, and may improve the ease of care and quality of life of children with CP, but the level of evidence is low.InterpretationDespite three decades of applying ITB in children and a relatively large number of studies investigating the treatment effects, a direct link has not yet been demonstrated because of the low scientific quality of the primary studies. Further investigation into the effects of continuous ITB at all levels of the ICF‐CY is warranted. Although large, controlled trials may be difficult to realize, national and international collaborations may provide opportunities. Also, multicentre prospective cohort studies with a long‐term follow‐up, employing harmonized outcome measures, can offer prospects to expand our knowledge of the effects of continuous ITB therapy in children.What this paper adds There is low‐level evidence for continuous intrathecal baclofen (ITB) in children with cerebral palsy.Continuous ITB is effective in reducing spasticity and dystonia in non‐controlled cohort studies.Evaluation of individual goals and systematic assessment of long‐term effects in large cohort studies are required.

Upper limb habilitation in children with hemiplegic cerebral palsy using a novel paediatric robotic device – Results from a Pilot Study

Objective: Based on rehabilitation of adult stroke patients using robotic therapy, we explored a similar approach for upper limb (UL) habilitation of children with hemiplegic cerebral palsy (CP). Methods: We used a novel paediatric robotic device, reachMAN2, for the habilitation of UL in children age 4 to 16 years with hemiplegic CP. This device trained 3 important movements: pinching movement using thumb and index finger, forearm supination/pronation and wrist flexion/extension. An interactive virtual reality game was developed to engage the child for robotic therapy. Each child had 10 robotic therapy sessions over 4 weeks under the supervision of a research assistant. At each session, the child had robotic therapy lasting 15 minutes for each of the 3 movements, with a 2-minute break in between. Each child had 3 functional assessments performed by paediatric occupational therapists: first before robotic therapy (week 0); second within 2 weeks of completing robotic therapy (week 4–6); the third at 3 months after starting robotic therapy (week 12–14). The Body Function Level assessment included measurements of the range of movement (ROM) using a handheld goniometer, for the joints at the thumb and index finger, forearm supination and wrist extension. Activity Level was assessed using relevant subtests in the Bruininks-Oseretsky Test of Motor Proficiency 2nd Ed. (BOT-2). Results: We had 6 subjects, average age 7 year 10 months. At 3 months, the ROM at the metacarpo-phalangeal joints of the thumb and index finger, and forearm supination, had increased above 10% from the baseline. There was also improvement in the age equivalence achieved for the subtests of fine motor precision, fine motor integration and manual dexterity in the BOT-2, which ranged from 4 to 12 months. Conclusion: This pilot study established the feasibility of robotic habilitation for children with hemiplegic CP with some UL functional benefits achieved.

Unilateral and bilateral upper limb dysfunction at body functions, activity and participation levels in people with multiple sclerosis

Background: There has been limited research on upper limb dysfunction in people with multiple sclerosis (PwMS). Objective: The objective of this paper is to study unilateral and bilateral upper limb dysfunction at different International Classification of Functioning (ICF) levels according to overall disability in PwMS. Methods: A total of 105 PwMS (16 with EDSS<4 (mild); 17 with EDSS 4–5.5 (moderate); 37 with EDSS 6–6.5 (severe); 35 with EDSS>6.5 (severe non-ambulant)) were recruited from two rehabilitation centers and assessed in a cross-sectional study. Results: The whole sample showed a diminished sensory function (median (first/third interquartile)) score of 3 (2/3) on the Monofilament Test and a reduced strength 91 (76/100) points on the Motricity Index (Body-Function level). Sensory dysfunction did not increase with higher EDSS while strength decreased from 100 (86/100) in the mild subgroups to 91 (80/100) points in the severe subgroup. All showed diminished dexterity, scoring 0.28 peg/s (0.17/0.35) on the Nine-Hole Peg Test (NHPT) (activity level). Score was better for the mild (0.38 (0.35/0.46)) peg/s compared to the severe subgroup (0.28 (0.17/0.35)). Sixty-eight percent, 44% and 75% of PwMS showed bilateral disorders in sensation, strength and dexterity, respectively. The Community Integration Questionnaire (participation level) showed a 35% reduction in home activities, even among PwMS with EDSS<4. Conclusion: This study showed uni-/bilateral upper limb abnormalities at all ICF levels increasing with the overall disability.

Comparing integrated training of the hand and arm with isolated training of the same effectors in persons with stroke using haptically rendered virtual environments, a randomized clinical trial.

BackgroundRobotically facilitated therapeutic activities, performed in virtual environments have emerged as one approach to upper extremity rehabilitation after stroke. Body function level improvements have been demonstrated for robotically facilitated training of the arm. A smaller group of studies have demonstrated modest activity level improvements by training the hand or by integrated training of the hand and arm. The purpose of this study was to compare a training program of complex hand and finger tasks without arm movement paired with a separate set of reaching activities performed without hand movement, to training the entire upper extremity simultaneously, utilizing integrated activities.MethodsForty individuals with chronic stroke recruited in the community, participated in a randomized, blinded, controlled trial of two interventions. Subjects were required to have residual hand function for inclusion. The first, hand and arm separate (HAS) training (n = 21), included activities controlled by finger movement only, and activities controlled by arm movement only, the second, hand and arm together (HAT) training (n = 20) used simulations controlled by a simultaneous use of arm and fingers.ResultsNo adverse reactions occurred. The entire sample demonstrated mean improvements in Wolf Motor Function Test scores (21%) and Jebsen Test of Hand Function scores (15%), with large effect sizes (partial r2 = .81 and r2 = .67, respectively). There were no differences in improvement between HAS and HAT training immediately after the study. Subjects in the HAT group retained Wolf Motor Function Test gains better than in the HAS group measured three months after the therapy but the size of this interaction effect was small (partial r2 = .17).ConclusionsShort term changes in upper extremity motor function were comparable when training the upper extremity with integrated activities or a balanced program of isolated activities. Further study of the retention period is indicated.Trial registrationNCT01072461.Electronic supplementary materialThe online version of this article (doi:10.1186/1743-0003-11-126) contains supplementary material, which is available to authorized users.

Perceived disability, fatigue, pain and measured isometric muscle strength in patients with post‐polio symptoms

Several years after the acute polio illness, patients may develop new post-polio symptoms. The purpose of the present study was to evaluate patients with post-polio symptoms with regard to perceived fatigue, functional ability, muscle strength, pain and with regard to measured physical fitness and isometric muscle strength. In addition, the relationship between the results of these subjective and objective measurements was investigated. This was a prospective cross-sectional study in which 32 patients with post-polio symptoms were included. Main outcome measures were the Fatigue Severity Scale (FSS), the Disability Rating Index (DRI), pain intensity, pain distribution, self-reported and measured muscle strength and oxygen uptake. A marked reduction in isometric muscle strength compared to normal data, high scores in fatigue, widespread pain, low oxygen uptake and difficulties in performing some daily activities were found. Self-reported general muscle strength, pain intensity and pain distribution correlated significantly with patients' perceived fatigue and function at the activity level. There was no significant correlation between self-reported and measured results except for that found between isometric muscle strength in the legs and patients' perceived general muscle strength and oxygen uptake. Evaluation of pain intensity, pain distribution, perceived muscle strength, fatigue and ability to perform daily tasks reveals important aspects of health status in patients with post-polio symptoms. Reduction in isometric muscle strength was not reflected in those tests or in reported symptoms, and should be monitored independently using a sensitive assessment tool. Accurate screening of isometric muscle strength in isolated muscle groups contributes to therapeutic management in making a functional diagnosis at the level of body function and structure when designing specific training programmes and in motivating patients. An evaluation combining self-reports with sensitive muscle strength measures provide supplementary information and is appropriate for evaluating these patients in physiotherapy practice.

Predictive Value of Ischemic Lesion Volume Assessed With Magnetic Resonance Imaging for Neurological Deficits and Functional Outcome Poststroke: A Critical Review of the Literature

Objective. Ischemic lesion volume is assumed to be an important predictor of poststroke neurological deficits and functional outcome. This critical review examines the methodological quality of MRI studies and the predictive value of hemispheric infarct volume for neurological deficits (at body function level) and functional outcome (at activities level). Methods. Using Medline, PiCarta, and Embase to identify studies, 13 of the 747 identified studies met the authors’ inclusion criteria. Subsequently, studies were tested for adherence to the key methodological criteria for internal, statistical, and external validity. Each criterion was weighted binary, and studies with 6 points or more were judged to be valid for assessing the predictive value of MRI for outcome. Results. The 13 included studies had several methodological weaknesses with respect to internal validity, and none of them took lesion location into account. Only a few used outcome measures according to the International Classification of Functioning, Disability and Health and followed patients beyond 6 months. Correlation coefficients between MRI lesion volume and outcomes were higher for outcomes defined at body function level (National Institutes of Health Stroke Scale; median 0.67; range: 0.57-0.91) than for those defined at the level of activities (Barthel Index; median -0.49; range: -0.33 to -0.74). Conclusions. Methodological shortcomings of most studies confound the prognostic value of MRI in predicting stroke outcome, and few studies have focused on functional outcome. Future studies should investigate the added value of MRI volume over clinical neurological variables in predicting functional outcome beyond 6 months poststroke.

Improving the Use of Hands in Daily Activities

Effective treatment for children with cerebral palsy requires a careful analysis of the behavior taking into consideration the complex issue of using the hands. In addition, it is important that the treatment is grounded in well-defined theories and methods. With the assistance of the International Classification of Functioning, the ICF, examples are provided of the effect of treatment on the level of Body Function. On the Activity Level, examples are given of treatment that applies recent knowledge of motor control and principles of motor learning. This paper is not intended to be a review of the literature, but rather, a set of examples from basic science, clinical practice and studies of intervention that highlight the possibilities of improving the usefulness of the hands in daily life.